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[Management of caustic burns of the esophagus in children]
J P Marie1, D Dehesdin, E De Sevin
1Service ORL Infantile et Audiophonologie, Hôpital Charles Nicolle, 1, Rouen.
Insights
This study outlines a therapeutic strategy for pediatric caustic esophageal burns, emphasizing early endoscopy and stenting for severe cases to prevent strictures. Treatment involves endoscopic dilatation for strictures, with surgery reserved for complex cases.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Endoscopy
Context:
- Caustic ingestion in children can lead to severe esophageal injury.
- Esophageal strictures are a significant long-term complication of caustic burns.
- Prompt and accurate assessment of esophageal damage is crucial for effective management.
Purpose:
- To describe a comprehensive therapeutic approach for managing caustic esophageal burns in pediatric patients.
- To detail the diagnostic and interventional steps, including endoscopic evaluation, stenting, dilatation, and surgical options.
- To outline a treatment algorithm based on the severity of esophageal injury.
Summary:
- The approach involves early endoscopic evaluation under general anesthesia to stage esophageal burns.
- Stages II and III burns, associated with stricture risk, necessitate nasogastric stent placement.
- Follow-up endoscopy assesses healing, with nasogastric tube removal and esophagography. Strictures are managed with serial endoscopic dilatations; surgery is a last resort.
Impact:
- This strategy aims to minimize long-term esophageal strictures and improve outcomes for children with caustic burns.
- It provides a structured management plan for clinicians dealing with these complex pediatric cases.
- The described interventions can potentially reduce the need for extensive surgical reconstruction.
Abstract:
The authors describe their therapeutic approach to caustic burns of the esophagus in pediatric patients. Initially, early endoscopic evaluation is carried out under general anesthesia using a stiff tube then a fiberoptic endoscope. During this procedure, severity of esophageal damage is determined: stage I: mild burn requiring no treatment; stages II and III: severe burn with a risk of subsequent esophageal stricture requiring insertion of a nasogastric stent. A repeat endoscopy is performed after approximately 25 days to evaluate healing. If healing has occurred, the nasogastric tube is removed and dynamic esophagography is performed 2 to 7 days later. Patients with strictures should be treated with repeated endoscopic dilatation at gradually increasing intervals. Surgery is indicated only in patients with complications or multiple strictures after failure of dilatation; trans-mediastinal colon esophagoplasty with removal of the burned esophagus is the method of choice.